It has to be said that there are almost as many answers to this question as there are acupuncturists. However, the main possibilities are as follows:
The sites are chosen in accordance with TCM (channels, points, yin-yang etc.).
The sites are chosen in accordance with some modern reinterpretation of TCM. Electrical apparatus may be used and there may be little resemblance to the ancient system; however concepts of ‘energy balancing’ are usually retained.
Cookbook (see below)
This is a very simplified version of TCM, lacking any theoretical foundation but relying on the concepts of channels and points.
Sites are selected on the basis of modern knowledge of the spinal segments, the needles being inserted in the relevant dermatome, myotome, or sclerotome. In its simplest form this consists merely in needling the painful area itself.
Acupuncture treatment areas
ATAs are needled.
Occasionally just one point is used in all patients (e.g. G 41 to treat headache). Such drastic simplification has characterized some research studies but few acupuncturists take their scepticism about acupuncture points as far as this.
My own approach is eclectic and I use most of the above methods on occasion. However I use mainly d) and e) though with the addition of certain traditional points. For the most part I consider these as sites at which it is possible to produce a profound generalized effect, though I keep open the possibility that there are also specific effects associated with the points as envisaged by TCM. In common with many other acupuncturists I find that my ideas on this fascinating subject are constantly changing, which is as it should be.
The obvious, if unhelpful, answer is “as deep as necessary”. Simply penetrating the skin provides a strong stimulus for many patients. If one is aiming to hit a muscle TP directly it may be necessary to penetrate deeply in some places. The technique of periosteal acupuncture obviously requires deeper penetration than would otherwise be the case.
Traditionalists usually leave needles in for 20 min. or more. The kind of acupuncture I practise relies on minimal stimulation, often for only a few seconds and seldom more than 2 minutes. This may seem very little but experience suggests that it is difficult to under-treat patients but very easy to over-treat them.
How many needles?
Again, the traditionalists generally used many needles. In contrast, the kind of acupuncture I advocate may use only one needle, at least on the first occasion; it is unusual to insert more than 4.